One solution may be to cease therapy with these medications when pregnancy is contemplated or confirmed. However, women who stop taking medications during pregnancy experience high relapse rates.4 Suicidal behaviour, poor self-care, inadequate nutrition and poor antenatal clinic attendance, with a consequent lack of fetal monitoring, can all present risk to the fetus. Another aspect of mental illness during pregnancy is the possible direct effect of maternal illness per se on the fetus. Some studies have found an association between antenatal anxiety in women and increased obstetric complications such as prematurity, low birth weight,5 smaller head circumference and poorer scores on neonatal neurological examination.6 Women of low socioeconomic status who have depression have higher rates of premature and low birth-weight infants,7 while women with bipolar disorder who are not medicated also have higher rates of neonatal deaths and structural anomalies.8,9 One meta-analysis reports a higher incidence of obstetric complications in women with schizophrenia, regardless of whether the illness (and medications) began before or after delivery.10
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